Histopathological prognostic factors for
colorectal liver metastases: A systematic review and meta-analysis of observational studies
Cássio Virgílio Cavalcante de Oliveira1,2,3, Gilton Marques Fonseca1, Jaime Arthur Pirola Kruger1, Evandro Sobroza de Mello4, Fabricio Ferreira Coelho1 and Paulo Herman1
1Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School (USP), São Paulo, 2Surgery Department, Paraíba Federal University, 3Nova Esperança Medicine Faculty, João Pessoa, Paraíba and 4Cancer Institute of the State of São Paulo "Octavio Frias de Oliveira" (ICESP), Department of Pathology, University of São Paulo Medical School (USP), São Paulo, Brazil
Corresponding Author: Cássio Virgílio Cavalcante de Oliveira, MD, Rua Dr. Arnaldo Escorel, 204 – Tambauzinho, João Pessoa – PB, Zip code 58042-080 Brazil. e-mail: cassiovco@terra.com.br
Summary. Summary. Introduction. Resection is the mainstay of treatment for colorectal liver metastases (CRLMs). Many different histopathological factors related to the primary colorectal tumour have been well studied; however, histopathological prognostic factors related to CRLMs are still under evaluation. Objective. To identify histopathological factors related to overall survival (OS) and disease-free survival (DFS) in patients with resected CRLMs.
Methods. A systematic review was performed with the following databases up to August 2020: PubMed, EMBASE, Web of Science, SciELO, and LILACS. The GRADE approach was used to rate the overall certainty of evidence by outcome.
Results. Thirty-three studies including 4,641 patients were eligible. We found very low certainty evidence that the following histopathological prognostic factors are associated with a statistically significant decrease in OS: presence of portal vein invasion (HR, 410.50 [95% CI, 0.37 to 0.68]; I2=0%), presence of perineural invasion (HR, 0.55 [95% CI, 420.36 to 0.83]; I2=0%), absence of pseudocapsule (HR, 0.41 [CI 95%, 0.29 to 0.57], p<0.00001; I2=0%), presence of satellite nodules (OR, 0.45 [95% CI, 0.26 to 0.80]; I2=0%), and the absence of peritumoural inflammatory infiltrate (OR, 0.20 [95% CI, 0.08 to 0.54]; I2=0%). Outcome data on DFS were scarce, except for tumour borders, which did not present a significant impact, precluding the meta-analysis.
Conclusion. Of the histopathological prognostic factors studied, low- to moderate-certainty evidence shows that vascular invasion, perineural invasion, absence of pseudocapsule, presence of satellite nodules, and absence of peritumoral inflammatory infiltrate are associated with shorter overall survival in CRLMs. Histol Histopathol 36, 159-181 (2021)
Key words: Colorectal cancer, Metastasis, Hepatectomy, Pathology, Prognosis, Surrogate markers, Systematic review, GRADE
DOI: 10.14670/HH-18-274
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©The Author(s) 2021. Open Access. This article is licensed under a Creative Commons CC-BY International License. |
